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May 9, 2019 at 9:27 AMMay 9, 2019 at 9:32 AM

Katrina Bowman has dealt with a lot in her 16 years as a surgery nurse.So when her blood pressure started rising one day last year, about seven months into a pregnancy that had included severe preeclampsia, she knew it was time to call the doctor and get things checked out.Her daughter, Kinley, was delivered via cesarean section a short time later, about two months earlier than expected.For many new moms facing comparable health issues, C-sections are a necessity. But for Bowman, 37, it was the preferred choice for delivery.“I wanted a C-section,” said Bowman, a nurse at OhioHealth Riverside Methodist Hospital in Columbus, Ohio. “It’s probably the surgical nurse in me. ... Surgery is my life. It seemed more controlled and planned out.”What she didn’t want, however, were copious amounts of prescription opioids for the pain that comes with cutting through skin and muscle.Enter the “On-Q Pain Relief System,” informally called the “pain ball” by those in the know. The pain ball delivers a nonaddictive, numbing anesthetic through a catheter directly to surgical incisions. It’s one of a number of opioid alternatives being used to help moms who have had C-sections deal with post-surgery discomfort.Bowman was up and moving within 24 hours of giving birth. “It was amazing,” she said.When Dr. Anita Somani started her obstetrics/gynecology practice more than 25 years ago, expectant mothers weren’t thinking as much about opioids and the addiction issues that dominate today’s headlines. Now, they’re more aware of the dangers, and they don’t want to expose their babies to unnecessary narcotics when breastfeeding.Those concerns can be taken too far, said Somani, who practices through Comprehensive Women’s Care and performs deliveries and other operations at Riverside.“Most studies show that if you only take (opioids) for seven days and you don’t get refills, you’re less likely to then become addicted,” Somani said. “It’s the people who are getting multiple prescriptions, they tend to become more dependent.”State officials have implemented a number of changes in recent years to shift guidelines and better monitor narcotics prescriptions, ultimately reducing the number of painkillers provided to patients. For five years running, such prescriptions have declined; there were 225 million fewer doses dispensed between 2012 and 2017, according to the Ohio Department of Health.Doctors have changed their approach to pain treatment, too.“We prescribe less narcotics, and our patients are using less narcotics,” Somani said. “That’s the goal, to adequately treat pain without creating a situation where someone becomes dependent.”In simple terms, opioids attach to receptors in the body, providing relief. The pain is still there, “it just makes you not care about the pain,” said Megan Little, a nurse and territory manager for Georgia-based Avanos Medical, the maker of On-Q. “It doesn’t directly treat the pain sensors or block pain signals. ... It more treats the mental aspect of the body and providing that sedation and relaxation.”If narcotics are used over time, it takes higher doses to achieve the same effect for some patients, she said. But the pain ball uses an anesthetic, rather than an opioid, that is designed to be nonaddictive. A thin catheter delivers the medicine into incision areas, with medication flowing directly into muscle and tissue through tiny holes. The device is carried in a small bag, and patients remove the catheter themselves after a few days.The device has been in use for about 20 years for different types of surgeries. Somani is among Columbus, Ohio area doctors who in more recent years have adopted it for most of her C-section mothers.There was a time when it was standard for Somani to prescribe 40 pills — a supply for about 10 days — to her C-section patients. Today, the total is closer to 20 pills, or a five-day supply, in part thanks to the use of the pain ball.“We’ve cut it in half,” she said. “I won’t say never, but it’s very rare that someone calls back” for a refill.For her C-section patients, the first five days after surgery are often the hardest, Somani said. The On-Q helps numb the pain for about five days, and she prescribes painkillers for the next five. Often, her new moms don’t use the pain pills.That was the case for Bowman, who lives in Lancaster, Ohio, with her husband, Zach.Bowman, who spent nearly two months at Riverside in early 2018 (about two weeks dealing with her own blood pressure and other issues, and more than five weeks while Kinley remained in the neonatal intensive-care unit), said she was well aware of the dangers of opioid overuse. But she said she didn’t think a lot about painkillers and C-sections until she gave birth herself.The resulting pain? Bowman described it as similar to a charley horse in your leg that won’t go away.“They literally cut your abdominal muscles, so any muscles that you have to sit up and move are gone,” she said. “You can’t even stand up. ... You can’t move. And if you do move, it just hurts.”Bowman has assisted in placing pain ball catheters for years, so she was familiar with the setup and the benefits. After her surgery, with the help of an On-Q, she was up and moving quickly, allowing her to bond with and breastfeed her daughter without relying on opioids.“It’s a great alternative,” she said.

-- Marc Kovac is a reporter for the Columbus (Ohio) Dispatch. He can be reached at 330-541-9400 or mkovac@dispatch.com

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